Advanced imaging

image of Advanced imaging
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Although conventional radiographic examination continues to play a central role in the initial diagnostic imaging evaluation or cardiorespiratory disorders, newer imaging modalities including ultrasonography , computed tomography (CT) and magnetic resonance imaging (MRI) are becoming increasingly important for more enhanced documentation of disease and for improved therapeutic planning and monitoring. Although these advanced imaging technologies are often not directly accessible to the general practitioner, it is important to have an understanding of the clinical uses for these imaging modalities and to recognize when referral for such studies is indicated. This chapter looks at Fluoroscopy; and Computed tomography and magnetic resonance imaging.

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Image of 7.1
7.1 Fluoroscopic image of the thorax of a dog in lateral recumbency during end-inspiration. The head is to the left of the image. The curvilinear black lines define the dorsal and ventral margins of the intrathoracic trachea. Fluoroscopic image at end-expiration during induction of a cough, revealing complete collapse of the intrathoracic trachea.
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7.2 Transverse CT image of a dog with bronchitis acquired at the level of the cranial lung lobes. The bronchial walls are thickened (arrowhead) and are easily followed out to the lung periphery. There is a focal alveolar pattern present in the dependent region of the left cranial lung lobe indicative of focal bronchopneumonia.
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7.3 Transverse CT image of a cat with chronic airway disease acquired at the level of the caudal lung lobes. The airways are prominent and the walls are uniformly thickened (arrowheads). Transverse CT image of another cat with chronic inflammatory airway disease acquired at the level of the caudal lung lobes. The branching linear opacities (arrowheads) represent bronchi occluded with inspissated bronchial secretions.
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7.4 CT image of a dog with severe generalized bronchiectasis acquired at the level of the caudal and accessory lung lobes. The large circular thick-walled lucencies in the caudal lobes represent markedly dilated bronchi in cross-section. Centrally a large bronchus is seen in long axis. This bronchus is markedly enlarged and sacculated.
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7.5 CT image of a dog with a large primary lung tumour involving the right caudal lung lobe. The mass is not seen in this CT slice but there is a regional increase in pulmonary opacity in the right caudal lobe (dorsally) and right middle lobe (ventrally) due to peritumoral oedema. This is typical of an interstitial ‘ground-glass’ opacity that results in an increase in pulmonary density but does not obscure vascular and bronchial wall margins.
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7.6 CT image of a dog with bronchopneumonia. The prominent increased opacity in the right ventral thorax represents an alveolar pattern due to consolidation within the right middle lung lobe. Branching air bronchograms can be seen. A similar but less defined pattern is also present ventrally in the caudal segment of the left cranial lung lobe.
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7.7 Contrast-enhanced CT images of a large spherical mass in the right caudal lung lobe viewed using soft tissue settings. A small volume of gas was seen along the dorsal and ventral rim of this mass when viewed using standard settings for lung evaluation. The mass has a hypodense (fluid) core surrounded by an irregular, contrast-enhancing rim. Findings are consistent with a diagnosis of pulmonary abscess, which was confirmed surgically.
Image of 7.8
7.8 CT image of a large moderately well marginated soft tissue mass in the right caudal lung lobe. The lucency evident centrally represents a bronchus preserved within the expansile mass. The mass was confirmed to be a bronchoalveolar carcinoma. CT image of a dog with a previously diagnosed malignant nerve sheath tumour. Multiple irregularly margined soft tissue nodules are present in all lung lobes. The nodules were confirmed to represent widespread pulmonary metastasis.
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7.9 CT image of a dog with multiple pulmonary bullae (arrowheads). The bullae are differentiated from bronchi in cross-section due to size, lack of associated pulmonary arteries and veins, and a spherical rather than cylindrical shape when multiple consecutive images are viewed. CT image of a dog with spontaneous pneumothorax. Free pleural air is present in the non-dependent region of the left pleural space (*). As it is not fully expanded, the remainder of the lung is denser than normal and could obscure concurrent pulmonary pathology.
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7.10 Contrast-enhanced CT image of the thorax of a dog with a mediastinal mass acquired at the level of the cranial mediastinum, immediately cranial to the heart. Histopathology confirmed a thymoma. B = Brachiocephalic trunk; C = Cranial vena cava; E = Air-dilated oesophageal lumen; L = Left subclavian artery; M = Cranial mediastinal mass; T = Tracheal lumen.
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7.11 Contrast-enhanced CT image of the thorax of a dog with pulmonary thromboembolism. The right pulmonary artery (arrowed) is distended, has irregular margins and a non-uniform density, indicative of intraluminal filling defects. The left pulmonary artery (arrowhead) is smaller and shows no evidence of intraluminal contrast enhancement, indicating a loss of flow. (Courtesy of T. Schwarz.)
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7.12 Contrast-enhanced T1-weighted transverse image of a canine heart at the level of the ventricles. L = Left ventricle; R = Right ventricle.
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7.13 Delayed contrast-enhanced CT image of a dog with a chemodectoma located at the heart base. This is a solid soft tissue mass with a mildly heterogenous pattern of contrast enhancement. AA = Ascending aorta; DA = Descending aorta; M = Mass; RA = Right atrium.
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